INVESTIGATION OF THE THORACIC FLUID CONTENT IN PATIENTS WITH POLYTRAUMA IN THE PRESENCE OF PULMONARY CONTUSION

Biletskyi O. V., Kursov S. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Increased of thoracic fluid content is associated with the formation of acute respiratory failure. In patients with pulmonary contusion, fluid accumulation in the lungs occurs due to hemorrhages into the lung tissue, an inflammatory reaction with increased capillary permeability and the transition of intravascular fluid to the pulmonary interstitium. Arterial and venous hypoxemia contributes to increased fluid loss from the vessels. Estimation of the amount of fluid in the chest is an important component of monitoring that helps determine the effectiveness of intensive therapy. The purpose of investigation was to study dynamics of the thoracic fluid content (TFC) by monitoring the magnitude of thoracic electrical impedance in patients with polytrauma in presence of pulmonary contusion in the course of intensive care. Methods. We examined 38 patients with polytrauma, each of whom had a blunt thoracic injury with pulmonary contusion. All patients had signs of acute respiratory failure syndrome. All patients needed respiratory support with oxygen. Central hemodynamics has studied by the method of thoracic tetrapolar rheoplethysmography according to Kubicek. The oxygen tension in the arterial blood has determined by an electrochemical method. Thoracic fluid content was determined by measuring the thoracic electrical impedance. We used two impedance methods for determining the value of thoracic fluid content. The first technique is generally accepted. In the first case, the value of thoracic fluid content has calculated in arbitrary units per unit of electrical biological impedance. The second technique developed by the authors of the study. In this case, the value of the thoracic fluid content has calculated using a mathematical model of the chest as a truncated cone. On basis of anthropometry data, the chest volume is calculated. The determination of the value of thoracic fluid content has carried out by modifying the Kubicek formula, taking into account the volume of the thorax, the value of electrical thoracic impedance and the specific electrical conductivity of the blood. Results. The results of thoracic fluid content determining with the help of both methods corresponded to the clinical course of pulmonary contusion. On the first day after the injury, patients discovered the presence of tachycardia, a moderate decrease in systolic blood pressure, mean arterial pressure, and a tendency for central venous pressure to rise. The stroke index of the heart was low and was on average 25.7 ± 3.9 ml/m2 , the average value of the heart index did not exceed 3.0 l/min./m2 . The arterial oxygen tension was on average 49.2 ± 10.5 mm Hg. The average oxygenation index was 245.9 ± 52.5. Without exception, all patients needed oxygen. According to the results of the well-known technique, thoracic fluid content exceeded 40 conventional units per 1.0 Ohm, and according to the authors’ method, it was 6932 ± 1225 ml or 68.44 ± 4.22% of the chest volume. On the fifth day, the condition of all patients has improved. Artificial lung ventilation in all patients has discontinued. However, 57.9% of patients needed oxygen therapy. Patients found a significant decrease in the severity of tachycardia, normalization of blood pressure and central venous pressure. All patients have increased contractile ability of the heart. Heart productivity returned to normal. The average level of oxygen tension in the blood exceeded 70 mm Hg, and the saturation of capillary blood with oxygen exceeded 90%. The oxygenation index rose and averaged 359.4 ± 58.0. The average thoracic impedance increased by 1.5 Ohms (p<0.001). According to the well-known method, the average value of thoracic fluid content decreased to 39.47 ± 2.97 conventional units per 1.0 Ohm (p<0.001). According to the authors ’method, the average value of thoracic fluid content was 6461 ± 1147 ml (p<0.001) or 64.53 ± 4.48% of the chest volume (p<0.001). A high closeness of the direct linear correlation between the values of thoracic fluid content, which were determined using two methods (r = 0.938), has found. There was a high closeness of the direct linear correlation between the value of thoracic fluid content and heart rate indicators (r =0.748), central venous pressure (r =0.814), cardiac stroke index (r = –0.748), the value of oxygen tension in arterial blood (r = –0.892), and the value of blood oxygen saturation (r = –0.804). Conclusion. In the study, the results of thoracic fluid content determining, as in the application of the generally accepted method, and when using the methodology of the authors of the work, fully corresponded to the clinical course of pulmonary contusion in patients with blunt chest trauma on the background of polytrauma. The volumetric and percentage content of the fluid in the chest, which was determined on the basis of measuring its electrical impedance, decreased with decreasing of severity manifestations of acute respiratory failure and central hemodynamic disorders inherent in this condition.

pulmonary contusion, acute respiratory failure, thoracic fluid content, electric thoracic impedance, central hemodynamics, polytrauma.

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«Bulletin of problems biology and medicine» Issue 2 Part 1 (150), 2019 year, 99-105 pages, index UDK [616.24-001-005.98-008.4+616.712]:616-001.31-035.1-092.6

10.29254/2077-4214-2019-2-1-150-99-105